Oncology Flashcards
28-year-old man is having inpatient chemotherapy for metastatic germ cell cancer. A staging CT scan the week before had shown widespread lung mets and bulky retroperitoneal lymph nodes. He had recently completed a course of ciprofloxacin for suspected orchitis. His routine bloods on day 2 following initiation of chemotherapy showed the following:
Sodium: 138 mmol/L, (137–144)
Potassium: 6.2 mmol/L, (3.5–5.3)
Creatinine: 215 μmol/L, (60–110)
Corrected calcium: 1.60 mmol/L, (2.20–2.60)
Phosphate: 1.52 mmol/L, (0.8–1.4)
Lactate dehydrogenase: 1238 U/L, (10–250)
Urate: 0.69 mmol/L, (0.19–0.36)
What is the most likely cause of the renal impairment?
A - Hepatorenal syndrome
B - Tumour lysis syndrome
C - Kidney infiltration
D - Intravenous contrast nephropathy
E - Ciprofloxacin toxicity
Tumour lysis syndrome
A 67-year-old woman completed chemo-radiotherapy for a T3N1 non-small cell lung cancer of her right upper lobe and is now receiving adjuvant immunotherapy in the form of Durvalumab, for which she has had 2 cycles. She presents to the department with a 3-day history of shortness of breath and dry cough. Her oxygen saturation is 88% breathing air and fine crackles are auscultated throughout both lungs.
Which is the most likely cause for her deterioration?
A - Immune-mediated pneumonitis
B - Neutropenia
C - Pulmonary embolism
D - Radiation pneumonitis
E - Heart failure
A - Immune-mediated pneumonitis
A 56-year-old woman is currently undergoing adjuvant chemotherapy for colorectal cancer. She presents to A&E, Day 12 after her 2nd cycle with a temperature of 38.2, pulse rate 110 bpm, BP 120/60 mm/Hg, respiratory rate 20 breaths per minute, oxygen saturation 98% breathing air. She has no other significant past medical history but is noted to have a penicillin allergy.
According to the local Tayside formulary, which is the appropriate choice of antibiotic?
A - Vancomycin
B - Ciprofloxacin
C - Tazocin
D - Meropenem
E - Teicoplanin and Aztreonam
E - Teicoplanin and Aztreonam
A 61-year-old man with colorectal cancer with metastatic spread to liver, abdominal and mediastinal lymph nodes complain of early morning headaches and croakiness in his voice.
What is the most likely cause?
A - Obstructive sleep apnoea
B - Superior vena cava obstruction
C - Brain metastases
D - Recurrent laryngeal nerve palsy
E - Hepatic encephalopathy
B - Superior vena cava
A 72-year-old man underwent a CT chest, abdomen and pelvis to investigate his weight loss. This demonstrated widespread metastatic disease. He has minimal past medical history but is increasingly fatigued to the point of spending most of his day sitting in his living room.
What performance status is he?
PS3
You are caring for a 42-year-old with breast cancer with brain metastases. They are experiencing nausea and vomiting. When taking a history, they tell you they are able to keep very little fluid and food down. They are vomiting bile and whatever they have drunk/eaten. There is no haematemesis. The nausea is worst in the morning. They have no abdominal pain and bowels have been moving regularly. On examination their abdomen is soft and non-tender with normal bowel sounds. On direct questioning they also tell you their head has been sore too.
What is the most likely cause of this nausea and vomiting?
A - Meningitis
B - Bowel Obstruction
C - Hypercalcaemia
D - Gastric stasis
E - Raised intracranial pressure
E - Raised intracranial pressure
A 60-year-old man with prostate cancer and type 2 diabetes mellitus complains of nausea and intermittent vomiting. He often vomits after meals and feels less nauseated afterwards. He has no abdominal pain and there is no haematemesis. Bowels are moving though sluggish. There is nothing concerning in his biochemistry and no new medications.
Which drug would you prescribe to help these symptoms?
A - Haloperidol
B - Ondansetron
C - Cyclizine
D- Metoclopramide
D - Metoclopramide
What is radical treatment?
Treatment given with curative intent
What is adjuvant therapy?
Treatment given following radical therapy with the intention of reducing the risk of disease recurrence.
What is neoadjuvant therapy?
Treatment given prior to the radical treatment
What is brachytherapy?
A source of radiation is implanted or inserted in the patient to deliver a dose of radiotherapy to a local tumour.
Describe “Performance Status”
0 – Fully active, no restrictions on activities
1 – Unable to do strenuous activities, but able to carry out light housework and sedentary activities
2 – Able to walk and manage self-care, but unable to work. Out of bed more than 50% of waking hours
3 – Confined to bed or a chair more than 50% of waking hours. Capable of limited self-cares
4 – Completely disabled. Totally confined to a bed or chair. Unable to do any self-care
5 – Death
